Provider Demographics
NPI:1952495616
Name:TALBERT, DAWN L (FNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:L
Last Name:TALBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-0758
Mailing Address - Country:US
Mailing Address - Phone:417-451-9450
Mailing Address - Fax:417-451-8903
Practice Address - Street 1:927 S 71 BUSINESS HWY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-9753
Practice Address - Country:US
Practice Address - Phone:417-845-2273
Practice Address - Fax:417-845-0094
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117259363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952495616Medicaid
MO429072200Medicaid
MOP01161780OtherPALMETTO GBA/RR MEDICARE
MOP01161780OtherPALMETTO GBA/RR MEDICARE
MO429072200Medicaid
MO132300259Medicare PIN